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Biomedical subjects

M Mantoni

Publications and source records attributed to M Mantoni.

At least 19 recordsLinked to original sources
PubMed2006

Long-term computed tomography follow-up after open surgical repair of abdominal aortic aneurysms.

PURPOSE: To describe the findings on computed tomography (CT) of the aortic sac (AS) in patients operated on for abdominal aortic aneurysm (AAA) with insertion of a coated Dacron prosthesis. MATERIAL AND METHODS: A prospective study of 36 consecutive patients operated on for AAA over 2 years and followed longitudinally with CT for up to 10 years. RESULTS: All patients had a fluid-filled AS on CT 7-10 days postoperatively. At 6 months, the AS had decreased in most patients, mainly in the antero-posterior diameter, and in two had disappeared completely. In five patients with complications, the AS increased in size. The AS disappeared completely at 10 years' follow-up in 13 patients. When present, a retroperitoneal hematoma always disappeared after 6 months. CONCLUSION: These data indicate that the AS after graft implantation will diminish gradually but will persist for at least 6 months. Usually the transverse diameter is bigger than the antero-posterior diameter. If the AS enlarges and becomes rounded and distended with an inhomogeneous interior, it might be a sign of graft infection. In these cases an ultrasound-guided or CT-guided puncture is recommended.

Adult↗
PubMed2002

Evaluation of chronic venous disease in the lower limbs: comparison of five diagnostic methods.

To compare the usefulness of five diagnostic methods in ensuring deep vein patency, and in demonstrating site(s) of incompetence, 39 patients with clinical signs of chronic venous disease of a leg were included in a study of deep, superficial and perforator veins using triplex ultrasound (TUS), ascending phlebography (AP), descending phlebography (DP), continuous wave Doppler (CWD) and ambulatory strain gauge plethysmography (ASGP). One patient withdrew from the study. It was not possible to use all five methods in all 38 cases, and the methods could only be used partly in some cases. TUS, which allows anatomical, morphological and functional evaluation of the venous system, was chosen as the reference method. There was poor agreement between TUS and AP, and no agreement between TUS and ASGP, in the diagnosis of venous occlusion. AP demonstrated reflux (abnormal valves) in 7 of 22 patients with competent veins at TUS, and missed reflux in 13 of 15 patients with incompetent veins. Similarly, CWD overdiagnosed reflux in 13 of 20 patients and missed the reflux in 3 of 14 patients. DP was only technically possible in 11 patients. ASGP diagnosed venous reflux in all patients with incompetent deep veins, but also indicated deep vein or perforator vein reflux in all but one patient with competent deep veins. The agreement between TUS and the other methods in evaluating reflux in the deep veins was not better than that expected to occur by chance, Cohen's kappa being less that 0.20. It is concluded that AP, CWD and ASGP are of little value in the work-up of patients with deep venous insufficiency.

Adult↗
PubMed2001

Ultrasound of limb veins.

Several imaging modalities are available for studying limb veins. Presently, the non-invasive duplex compression ultrasound and color Doppler imaging have replaced contrast venography as first-choice imaging modality in suspected deep vein thrombosis. This review discusses the current role of sonography and suggests a diagnostic strategy that minimises the need for contrast venography.

Humans↗
PubMed2000

Vestibular schwannoma growth--long-term results.

The growth of vestibular schwannoma (VS) was investigated in a series of 123 patients with 127 tumours during 3 periods: 1973 to 1993 (mean observation period 3.4 years), 1973 to 1996 (mean observation period 3.8 years) and 1973 to 1999 (mean observation period 4.2 years). Three sets of growth results were obtained. At the end of the first period, 94 tumours (74%) exhibited measurable growth, 23 tumours (18%) no measurable growth and 10 tumours (8%) negative growth. Tumour growth was observed in 104 tumours (82%), no tumour growth in 15 tumours (12%) and negative growth in 8 tumours (6%) at the end of the extended observation period. Growth was observed in 108 tumours (85%), no growth in 11 tumours (9%) and negative growth in 8 tumours (6%) subsequent to the third observation period. However, the results can be interpreted in another way: 52 patients (42%) are alive, tumour growth required no intervention; 23 patients (19%) died due to non-tumour-related causes; and 35 patients (28%) were previously treated and alive by the end of the third observation period. Together with other factors, the results reported here should be considered when timing of surgery is to be decided.

Adolescent↗
PubMed2000

Intracanalicular vestibular schwannoma--therapeutic options.

The growth of purely intrameatal vestibular schwannoma (VS) was investigated in a series of 40 patients with 40 unilateral VS in the period 1973 to 1996 (mean 3.6 years). Twenty-seven tumours (67.5%) revealed growth and 13 tumours (32%) had no measurable growth. Four growth patterns were observed: (i) 15 tumours (37.5%) exhibited constant growth; (ii) 13 tumours (32.5%) had no measurable growth; (iii) 8 tumours (20%) revealed growth subsequent to a no-growth period; and (iv) 4 tumours (10%) manifested different growth patterns during the observation period. The mean diameter growth per year was 3.2 mm. The findings of the present study, especially those achieved in groups B (the non-growing tumours) and C (tumour growth subsequent to a silent period), question the reliability of the results achieved by radiosurgery, as no tumour growth may occur with no intervention.

Adolescent↗
PubMed2000

Vestibular schwannoma growth: the continuing controversy.

OBJECTIVE: To investigate the growth of vestibular schwannoma (VS) in a series of 123 patients with 127 tumors allocated to the "wait and scan" group in the period 1973-1999. STUDY DESIGN: Retrospective review of prospectively registered data on all patients with VSIE from the entire country who were allocated to the wait and scan group. METHOD: Clinical charts, audiometric data, and neuroradiological images were reviewed and tabulated for age, hearing level expressed as speech reception threshold (SRT) and speech discrimination score (SDS), maximum extra-canalicular tumor extension, and possible changes in tumor diameter. The material was updated three times (in June 1993, June 1996, and June 1999). Via the Danish national register, data on whether the included patients were alive or dead were collected in 1999. RESULTS: The tumor growth, growth rate, and growth patterns were calculated in three periods 1973 to 1993 (mean observation period, 3.4 y), 1973 to 1996 (mean observation period, 3.8 y), and from 1973 to 1999 (mean observation period, 4.2 y). By termination of the first period, 94 tumors (74%) exhibited measurable growth, 23 tumors (18%) no measurable growth, and 10 tumors (8%) revealed negative growth. By the end of the extended observation period, tumor growth was observed in 104 tumors (82%), no tumor growth in 15 tumors (12%), and negative growth in 8 tumors (6%). Subsequent to the third observation period, growth was observed in 108 tumors (85%), no growth in 11 tumors (9%) and negative growth in 8 tumors (6%). However, the results may also be interpreted in another way: 52 patients (42%) were alive at the time of writing, tumor growth did not demand any intervention, 23 patients (19%) died as a result of non-tumor-related causes, and 35 patients (28%) were previously treated and alive by the termination of the third observation period. CONCLUSION: Depending on the observation period, three sets of growth results were obtained. The long observation period, updating and re-updating the results, gave us the opportunity for a de novo interpretation of the results and the long-term consequences of the wait and scan policy. Combined with other factors, the achieved results should be considered when timing of surgery is to be decided.

Adolescent↗
PubMed1999

Management of intrameatal vestibular schwannoma.

The growth of purely intrameatal vestibular schwannoma (VS) was investigated, in the period 1973-96 in a series of 40 patients with 40 unilateral VS. In the present study, the material was analysed and updated. By the end of the observation period (mean 3.6 years), 27 tumours (67.5%) revealed growth and 13 tumours (32%) had no measurable growth. Four growth patterns were observed: (A) 15 tumours (37.5%) exhibited constant growth; (B) 13 tumours (32.5%) had no measurable growth; (C) 8 tumours (20%) revealed growth subsequent to a no-growth period; and (D) 4 tumours (10%) showed different growth patterns during the observation period. The annual diameter growth rate ranged between 00 mm/year and 6.5 mm/year and the mean diameter growth per year was 3.2 mm. The findings of the present study, especially those for group B (the non-growing tumours) and C (tumour growth subsequent to a silent period) bring into question the reliability of the results achieved by radiosurgery, as without any intervention it may be that no tumour growth occurs.

Adolescent↗
PubMed1998

Acoustic neuroma/vestibular schwannoma growth: past, present and future.

The growth of vestibular schwannoma (VS) was investigated in a series of 123 patients with 127 tumors in the period 1973 1993. The material was reanalysed and updated 3 years later in 1996. By termination of the first observation period (mean 3.4 years), 94 tumors (74%) exhibited measurable growth, 23 tumors (18%) no measurable growth and 10 tumors (8%) negative growth. By the end of the extended observation period (mean 3.8 years), tumor growth was observed in 104 tumors (82%), no tumor growth in 15 tumors (12%) and negative growth in eight tumors (6%). Several growth patterns were noticed: however, these were not static as the growth patterns of the tumors changed during the extended observation period. Accordingly, the expected growth figures by the end of this century (mean observation period approximately 4 years) will probably be: growth in 111 tumors (87%), no growth in 10 tumors (8%) and negative growth in six tumors (5%). The results indicate that neither the present study nor the previously published studies on tumor growth reflect the natural history of VS, but they only provide information on tumor growth, growth rates and growth patterns during a given observation period.

Adolescent↗
PubMed1997

Triplex US in the diagnosis of asymptomatic deep venous thrombosis.

PURPOSE: To evaluate the accuracy of triplex ultrasound (TUS) compared with venography as a screening test for deep venous thrombosis (DVT), and to evaluate interobserver variation in the interpretation of the venographic studies. MATERIAL AND METHODS: A total of 133 postoperative hip fracture patients, asymptomatic of DVT, were prospectively examined with TUS and venography. All venograms were reviewed blindly and in case of disagreement a consensus was arrived at. RESULTS: The incidence of DVT was 20%, with isolated calf vein thrombi in 63% of the cases. There were 7 false-negative and one false-positive result/s at TUS, with a sensitivity of 74%, specificity of 99% and accuracy of 97%. The kappa values ranged from 0.58 to 0.82. The false-negative results were all caused by missed calf vein thrombi in technically inadequate examinations. At sonography 2% of vein segments were noninterpretable, compared to 29% at venography. CONCLUSION: Venous US is less sensitive as a test for DVT in this study of asymptomatic patients than in earlier studies on symptomatic patients. Still, sonographic screening of high-risk patients would be both effective and cost effective. Fresh thrombi may cause a false-negative compression test.

Aged↗
PubMed1996

Coronal CT of the paranasal sinuses before and after functional endoscopic sinus surgery.

Coronal CT of the paranasal sinuses and the ostiomeatal complex (OMC) was performed before and 12 months after bilateral functional endoscopic sinus surgery (FESS) in 30 patients with sinusitis and 12 patients with nasal polyposis. The extent of sinus mucosal thickening was graded, and the patency of the OMC was evaluated. After FESS, the percentage of open OMCs had increased from 42% to 83% in the sinusitis group, and from 8% to 45% in the polyposis group. There was only a small improvement in mucosal score in sinuses with opened OMC, so that the overall extent of sinus opacification before and after FESS was almost the same. Despite this, 91% of the patients reported clinical relief of symptoms. Preoperative coronal CT of the paranasal sinuses serves as an anatomical map for the surgeon, but there is no benefit of routine postoperative CT.

Adult↗
PubMed1996

Prevalence of renal artery stenosis in patients with peripheral vascular disease and hypertension.

The aim of this study was to evaluate the prevalence of renal artery stenosis in patients with clinical signs of peripheral vascular disease and hypertension. One hundred patients, mean age 69 years (range 45-88) with symptoms and clinical signs of severe peripheral ischemia, underwent aortography to determine the degree of peripheral vascular disease and possible renal artery stenosis. History of claudication, and measurement of systolic distal blood pressure (BP) and calculation of the Ankle Brachial Index was used to define the severity of peripheral vascular disease. A total of 31% had renal artery stenosis (14% greater than 50% reduction in luminal diameter). In a subgroup of patients with hypertension and peripheral vascular disease (n = 74), 34% had renal artery stenosis. In the subgroup of patients with renal artery stenosis, 81% have hypertension. Patients with renal artery stenosis and lumen reduction of more than 50%, 93% have hypertension (P < or = 0.001). In conclusion this study shows that the combination of peripheral vascular disease and hypertension is an important clinical clue for renovascular disease. Examination for reno-vascular disease in this population should be considered, since the prevalence of the condition is high. Furthermore examination for renal vascular disease in this population is mandatory, before treatment with angiotensin converting enzyme (ACE) inhibitors is initiated, since treatment might lead to serious renal function impairment.

Aged↗
PubMed1995

Acoustic neuroma (vestibular schwannoma): growth and surgical and nonsurgical consequences of the wait-and-see policy.

A prospective study of the consequences of the wait-and-see policy in in patients with neuroradiologic diagnostic evidence of having vestibular schwannoma was conducted in a series of 123 patients (127 tumors) over a 20-year period, from 1973 to 1993. The mean follow-up period was 3.4 years, mean annual growth rate was 3.2 mm/year, mean annual volume growth rate was 0.72 ml/year, and mean annual relative growth rate was 41%. Tumor growth was observed in 90 (74%) patients (94 tumors), no growth was seen in 23 (18%) patients (23 tumors), and negative tumor growth was seen in 10 (8%) patients (10 tumors). Surgery due to tumor growth was performed in 35 (28%) patients (35 tumors), 7 (6%) patients (7 tumors) were treated with gamma-radiation and/or shunt insertion, 7 (6%) patients died of brain stem herniation induced by tumor compression, 9 (7%) patients died of non-tumor-related causes, 28 patients were classified as candidates for hearing preservation surgery, and 21 (75%) patients lost their candidacy during the observation period due to tumor growth and/or deterioration of hearing. The results may limit indications for allocation of patients with vestibular schwannoma to the wait-and-see group.

Adolescent↗
PubMed1995

Diagnosis of acute aortic occlusion by computer tomography.

We present a case of acute aortic occlusion, which was diagnosed immediately with CT. Since a prompt diagnosis is essential we recommend contrast enhanced CT as a quick procedure to confirm diagnosis and to exclude dissecting thoracic aneurysm and genuine abdominal aneurysm.

Aged↗
PubMed1994

Cystic vestibular schwannomas: neuroimaging and growth rate.

In a series of 571 vestibular schwannomas (VS) operated on in the period 1976-1992, via the translabyrinthine approach, 23 tumours (4 per cent) from 23 patients were radiologically, peroperatively and histologically identified as cystic VS. Neuroimaging examinations (CT and MRI) revealed 15 tumours (2.6 per cent) with extracystic formations and in eight cases (1.4 per cent) intratumoural cysts. In 15 cases (65 per cent), tumours were located extracanalicularly with no involvement of the internal auditory canal (IAC). The extracanalicular tumour extension including the cystic elements ranged between 10 and 60 mm with a mean of 45 mm. In eight cases out of 23 (35 per cent) other diagnostic possibilities such as trigeminal schwannoma, epidermoid cyst and meningioma were proposed at the primary evaluation. Deformation, displacement and/or impression of the fourth ventricle was demonstrated in 17 cases (74 per cent). Three patients (13 per cent) had obstructive hydrocephalus which demanded shunt insertion. Residual tumour was detected in two patients (9 per cent). Growth rate in four cases was more than 10 times higher when compared to the annual growth rate of noncystic VS. The results of this study provide data on cystic VS attenuation demonstrated by CT or MRI which may be valuable in neuroradiological diagnosis of these cystic lesions and emphasizes that the wait-and-see policy should not be applied to the cystic variant of VS.

Adult↗
PubMed1993

Histology and neuro-imaging in cystic acoustic neuromas.

Tumor configuration and attenuation on CT scan with contrast enhancement or gadolinium-DTPA-enhanced MR depends upon tumor histology. Various elements are responsible for the density on CT or MR, e.g. blood vessels, fatty tissue, connective tissue, calcium, necrotic tissue, hemorrhage and intra- or extratumoral cyst formation. In a series of 571 acoustic neuromas we found 23 cystic tumors. The diagnosis was based on neuro-imaging examination, confirmed at surgery and finally verified histologically. Eight tumors with small or large cysts were diagnosed by CT or MR scan as intratumoral, and 15 with large cysts were diagnosed as extratumoral. We found a good correlation between the histology of cystic acoustic neuromas and the CT or MR scans. The tumors were predominantly hypodense, corresponding to the cystic areas, but also iso- or hyperdense areas were observed, corresponding to other tissue types. Antoni type B tissue and xanthomatous areas were found in all 23 cases.

Cell Membrane↗
PubMed1992

Glutathione treatment of hepatocellular carcinoma.

This prospective study was undertaken to substantiate observations that glutathione (GSH) inhibits or reverses tumor growth in humans with hepatocellular carcinoma (HCC), a neoplasm with an extremely poor prognosis. Eight patients with biopsy-proven HCC not amenable to surgery were given 5 g of GSH daily from the time of diagnosis. Two patients withdrew shortly after receiving GSH due to intolerable side-effects. Of the six eligible patients, two had mildly advanced tumors and four moderately advanced tumors. At 1-2-month intervals the liver was CT and ultra-sound scanned to assess the growth status of the tumor (progression, stagnation or regression). All the patients, except a male with a fibrolamellar type of HCC, died within 1 year after diagnosis. Two women with moderately advanced tumors survived almost 1 year, tumor growth stopped or regressed and in one of the women an initially abnormal alfa-1-fetoprotein (AFP) returned to normal after GSH treatment. AFP remained normal throughout the treatment period in the other women. These observations indicate that GSH may have a sex-dependent effect on HCC. However, further studies involving more patients are required to pursue this hypothesis.

Adult↗
PubMed1991

Deep venous thrombosis: longitudinal study with duplex US.

Forty-nine patients with deep venous thrombosis (DVT) of the lower limb were studied with repeated duplex ultrasound (US) for at least 1 year or until the vein became normal at US. Standard anticoagulant therapy was given for 3 months. In 36 patients, the veins became normal within 1 year. The likelihood of normalization increased if the lesion was located in only one site, if the pelvic veins were unaffected, if the affected leg was the left one, if the initial clot was nonocclusive, if there was no history of DVT, and if the symptoms had lasted less than than 24 hours. The average time before normalization was shorter if the symptoms had lasted less than 24 hours, that is, 11 weeks versus 25 weeks (P less than .02). The rate of sequelae at 1 year was lower if the US scan was normal or showed regression at 3 months, 6% versus 83% (P less than .00005).

Adolescent↗